Mayor Dennis E. Pauley
Liquor Commissioner
1528 - 3rd Avenue
Rock Island, IL. 61201
Telephone: (309) 732-2012
APPLICATION FOR LIQUOR LICENSE RENEWAL
Sec. 3-7. Licenses Generally: (a) Generally: No person shall sell, barter, transport, deliver, solicit or receive orders
for, keep or expose for sale, keep with intent to sell, or furnish any alcoholic liquor for sale at retail within the
corporate limits of the city without first having obtained a valid liquor license from the same.
1. Business Premise Information
Business Name: (Exactly as it appears on your license – including corporation, LLC, etc.)
Business Address:
City Issued Liquor License Number:
2. Owner Information
Name (Last, First, Middle Initial)
Home Address
Title
City
State Zip Code
Area Code / Telephone Number
3. Manager / Agent for the Business - Note: The Manager Must Be a Resident of Rock Island County.
If there has been a change, a “Manager Change Form” must also be completed to be in compliance.
Name (Last, First, Middle Initial)
Home Address
1
Title
City
State Zip Code
Area Code / Telephone Number
4. Hours of Operation
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
5. Does this establishment possess a current Illinois Video Gaming License? (check one)
Yes
No
If yes, please provide your VIDEO GAMING LICENSE NUMBER ______________________
6. Have you made an application for an Illinois Video Gaming License that is currently
pending? (check one)
Yes
No
If yes, please provide your VIDEO GAMING APPLICATION NUMBER _____________________
7. License Type & Options
Please check the type of license, along with any license options, for which you are applying: (check one)
License Types:
2
Annual Fee
_____ Class A - Packaged Sales Only, Primary Business (Liquor Store)
$1,100.00
_____ Class B - Packaged Sales Only, Secondary Business (Convenience / Grocery Stores)
$1,100.00
_____ Class C - Packaged Sales Only, Wine and Beer Only (Convenience / Grocery Stores)
$1,000.00
_____ Class D - Tavern with Packaged Sales Primary (more than 50% sold in packaged sales)
$1,430.00
_____ Class E - Tavern with Packaged Sales Secondary (less than 50% sold in packaged sales)
$1,100.00
_____ Class F - Restaurant
$1,100.00
_____ Class G - Restaurant, Wine and Beer Only
$ 700.00
_____ Class H - Theater / Bowling Center
$1,100.00
_____ Class I - Hotel / Motel
$1,100.00
_____ Class J - Banquet Facilities / Rental Hall
$1,100.00
_____ Class K - Clubs / Fraternal Organizations
$1,100.00
_____ Class L - City Owned Parks and Facilities
$ 275.00
Options: (check all that apply)
_____ Option 1 (Extended hours – 2:00 A.M. - available on Class D, E, F, G and K only)
$ 450.00
_____ Option 2 (Extended hours – 3:00 A.M. - available on Class D, E, F, G and K only)
$1,200.00
_____ Option 3 (Live entertainment – “limited”, Friday and Saturday only)
$ 220.00
_____ Option 4 (Live entertainment – “continuous”, seven days a week)
$ 440.00
_____ Option 5 (Caterer’s Options – available on B, C, D, E, F, G, J and L only)
$ 350.00
_____ Option 6 (Cabaret – Class E only, limited availability)
$ 550.00
Total Annual Fee
$______________
(license plus options)
Semi-Annually*
$ ______________
(*2 installment plan available, see below)
*To calculate semi-annual fee, divide total annual fee by two. Liquor licenses issued on a semi-annual basis shall be
subject to a FIFTY DOLLAR ($50.00) handling fee to be included with the regular license fee on the second six
(6) month period of any licensing year.
The second payment is due by October 24th of that licensing year.
NO REMINDER WILL BE SENT FOR THE SECOND PAYMENT.
NOTE: Dram shop liability insurance must be carried by Licensee. A current copy of a
Memorandum of Insurance to cover this licensing period must be presented before the license can
be renewed.
PLEASE READ AND SIGN:
I hereby certify that the activities of the licensed establishment as listed on the Application for Renewal have
not deviated during the past licensing period and that nothing has occurred and / or changed, which would
cause ineligibility for licensure since the Licensee was first issued a license. I further understand and agree to
abide by the Liquor Ordinance and laws of the City of Rock Island and State of Illinois during this renewal
period. I understand that in the event that any representation in the Application for Liquor License Renewal
is false, or is violated; my liquor license may be revoked.
Date:_____________________________
Signed:______________________________________
Title:________________________________________
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